BMC Anesthesiology最新文献

{"title":"Safety and efficacy of a novel dexmedetomidine nasal spray for pre-anesthetic sedation in children: a randomized, double-blind, placebo-controlled trial.","authors":"Jia Gao, Fang Wang, Xiaoling Wang, Xiaohua Zou, Hua-Cheng Liu, Xingrong Song, Xiaoqing Chai, Rong Jiang, Ping Zhao, Jiaqiang Zhang, Sai-Ying Wang, Haichun Ma, Zhibin Zhao, Quanren Wang, Na Zhou, Jianling Bai, Jianmin Zhang","doi":"10.1186/s12871-024-02708-1","DOIUrl":"10.1186/s12871-024-02708-1","url":null,"abstract":"<p><strong>Background: </strong>Off-label intranasal administration of injectable dexmedetomidine has been widely applied in the pediatric sedation setting. However, the development of an improved drug delivery system that is easy to use is needed. We developed a novel dexmedetomidine nasal spray that can be administered directly without dilution or configuration for pediatric pre-anesthetic sedation. This nasal spray has a fixed dose and is stable during storage. To the best of our knowledge, this is the first licensed nasal spray preparation of dexmedetomidine worldwide.</p><p><strong>Objective: </strong>To evaluate the pre-anesthetic sedation efficacy and safety of the novel dexmedetomidine nasal spray in children.</p><p><strong>Methods: </strong>The study was conducted at 11 sites in China between 24 November 2021 and 20 May 2022 and was registered in ClinicalTrials.gov (NCT05111431, first registration date: 20/10/2021). Subjects (n = 159) between 2 and 6 years old who were to undergo elective surgery were randomized to the dexmedetomidine group (n = 107) or the placebo group (n = 52) in a 2:1 ratio. The dosage was 30 µg or 50 µg based on the stratified body weight. The primary outcome measure was the proportion of subjects who achieved the desired child-parent separation and Ramsay scale ≥ 3 within 45 min of administration. Safety was monitored via the assessments of adverse events, blood pressure, heart rate, respiratory rate and blood oxygen saturation.</p><p><strong>Results: </strong>The proportion of subjects achieving desired parental separation and Ramsay scale ≥ 3 within 45 min was significantly higher in the dexmedetomidine group (94.4%) vs the placebo group (32.0%) (P < 0.0001). As compared with placebo, dexmedetomidine treatment led to more subjects achieving Ramsay scale ≥ 3 or UMSS ≥ 2, and shorter time to reach desired parental separation, Ramsay scale ≥ 3 and UMSS ≥ 2 (all P < 0.0001). Adverse events were reported in 90.7% and 84.0% of subjects in the dexmedetomidine and placebo groups, respectively, and all the events were mild or moderate in severity.</p><p><strong>Conclusions: </strong>This novel dexmedetomidine nasal spray presented effective pre-anesthetic sedation in children with a tolerable safety profile.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasonic assessment of gastric solid contents in patients undergoing upper endoscope with sedation.","authors":"Jing Wang, Xuan Yu, Ying Wang, JieLei Xu, Zhao Wang, Yi Zhang","doi":"10.1186/s12871-024-02688-2","DOIUrl":"10.1186/s12871-024-02688-2","url":null,"abstract":"<p><strong>Background: </strong>Perioperative reflux aspiration presents a grave concern during sedation or general anesthesia, particularly when solid gastric contents prompt acute upper respiratory obstruction, potentially resulting in fatal consequences for patients. Currently, there are limited means for promptly assessing solid gastric contents in clinical settings. Therefore, this study examined the efficacy of ultrasound assessment for solid gastric contents, offering a rapid and non-invasive approach for early detection and decision-making regarding interventions.</p><p><strong>Methods: </strong>The study included 400 patients scheduled for upper endoscopy procedures, which encompassed both gastroscope and gastroscope combined colonoscopy examinations with sedation. Ultrasound scanning of the antrum was performed while patients were positioned semi-sitting or in the right lateral decubitus (RLD) posture. The evaluation of solid gastric contents relied on direct visual observation during endoscopy. Gastric volume measurement occurred subsequent to endoscopic suction of gastric contents. Receiver operating characteristic curves were utilized to assess the effectiveness of ultrasonography in discerning solid contents.</p><p><strong>Result: </strong>Seven patients undergoing gastroscope with sedation were found to have solid gastric contents. The sensitivity, specificity, positive predictive value, and negative predictive value of the ultrasound qualitative evaluation of solid contents were 85.7%, 99%, 60%, and 99.7%, respectively.</p><p><strong>Conclusion: </strong>Solid stomach contents can be evaluated qualitatively with reasonable accuracy using ultrasonography. Additionally, in patients undergoing upper endoscopy and assessed to have solid gastric contents with ultrasound, administration of mild sedation is recommended.</p><p><strong>Trial registration: </strong>www.chictr.org.cn (ChiCTR2100048994); registered 19/07/2021.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative pain management interventions in opioid user patients: an overview of reviews.","authors":"Ava Tavakoli Vadeghani, Margaret Grant, Patrice Forget","doi":"10.1186/s12871-024-02703-6","DOIUrl":"10.1186/s12871-024-02703-6","url":null,"abstract":"<p><strong>Background: </strong>Every year, many opioid users undergo surgery, experiencing increased postoperative complications, inadequate pain control, and opioid-related adverse effects. This overview aims to summarise and critically assess the systematic reviews about perioperative pain management interventions, identify the knowledge gaps, and potentially provide high-quality recommendations to improve postoperative analgesia and surgical outcomes.</p><p><strong>Methods: </strong>A systematic search was conducted from the following databases, PubMed, Cochrane Database of Systematic Reviews, Embase, APA PsycINFO, CINAHL, AMED, Scopus, PROSPERO, ProQuest, and Epistemonikos, in June 2023. Additionally, reference lists were reviewed. The identified studies were assessed based on eligibility criteria and data extracted by a self-designed form and two independent reviewers. Qualitative data were synthesised, and all included studies were assessed by The Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) checklist.</p><p><strong>Results: </strong>Nine studies were included. The methodological quality of the studies was mostly critically low. Various interventions were identified, including perioperative management of buprenorphine, ketamine administration, multimodal analgesia, higher doses of medications, patient education, and interprofessional collaboration. The level of certainty of the evidence ranged from very low to high. One high-quality study showed that ketamine administration may improve perioperative analgesia supported with moderate to very low-quality evidence, and low and critically low studies indicated the efficacy of perioperative continuation of buprenorphine with low to very low-quality evidence.</p><p><strong>Conclusion: </strong>Perioperative continuation of buprenorphine and ketamine administration as a multimodal analgesia approach, with moderate to very low-quality evidence, improves pain management in opioid users and decreases opioid-related adverse effects. However, high-quality systematic reviews are required to fill the identified gaps in knowledge.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Ping-pong\" in the heart: a case report and literature review.","authors":"Yuantao Hou, Luyang Jiang, Ting Hai, Yi Feng","doi":"10.1186/s12871-024-02698-0","DOIUrl":"10.1186/s12871-024-02698-0","url":null,"abstract":"<p><strong>Background: </strong>Ball thrombus is rare and life-threatening. The correct diagnosis and timely management are key to improving patient prognosis. Here, we present a case report and literature review of ball thrombus.</p><p><strong>Case presentation: </strong>A 75-year-old woman presented to our outpatient clinic because of palpitations and chest distress for 8 months. She was diagnosed mitral stenosis, and transthoracic echocardiography (TTE) showed a round mass attached to the left atrial (LA) wall. Before anesthesia induction, TTE found that the mass has dropped from the LA wall, and was spinning in the LA causing intermittent obstruction of the valve. Anesthesia induction was then carried out under TTE monitoring, and transesophageal echocardiograph found another mass in the LA appendage after intubation. She underwent LA mass removal and mitral valve replacement, and was discharged uneventfully. Histopathology confirmed the diagnosis of thrombus. Our literature review identified 19 cases of ball thrombus between 2015 and 2024. The average age was 54.8 (range 3-88) years. Heart failure was present as the initial symptom in 11 cases, and most patients had mitral valve disease or concomitant with atrial fibrillation. 12 cases received surgery, and 7 received medical treatment only. 2 deaths occurred, one due to the obstruction of left ventricular inflow tract and the other due to the worsening of heart failure.</p><p><strong>Conclusion: </strong>Ball thrombus is rare in clinical settings. Urgent thrombectomy should be performed as soon as possible, and echocardiography can be used for real-time monitoring during surgery.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of muscle recovery in post-ICU patients admitted for acute pancreatitis: a longitudinal single-center study.","authors":"Clarissa Hosse, Nick L Beetz, Uli Fehrenbach, Aboelyazid Elkilany, Timo A Auer, Bernhard Gebauer, Christian Pille, Dominik Geisel, Johannes Kolck","doi":"10.1186/s12871-024-02687-3","DOIUrl":"10.1186/s12871-024-02687-3","url":null,"abstract":"<p><strong>Objectives: </strong>Critically ill patients with severe pancreatitis exhibit substantial muscle wasting, which limits in-hospital and post-hospital outcomes. Survivors of critical illness undergo extensive recovery processes. Previous studies have explored pancreatic function, quality of life, and costs post-hospitalization for AP patients, but none have comprehensively quantified muscle loss and recovery post-discharge. By applying an AI-based automated segmentation tool, we aimed to quantify muscle mass recovery in ICU patients after discharge.</p><p><strong>Materials: </strong>Muscle segmentation was performed on 22 patients, with a minimum of three measurements taken during hospitalization and one clinically indicated examination after hospital discharge. Changes in psoas muscle area (PMA) between admission, discharge and follow up were calculated. T-Test was performed to identify significant differences between patients able and not able to recover their muscle mass.</p><p><strong>Results: </strong>Monitoring PMA shows muscle loss during and gain after hospitalization: The mean PMA at the first scan before or at ICU admission (TP1) was 17.08 cm², at the last scan before discharge (TP2), mean PMA was 9.61 cm². The percentage change in PMA between TP1 and TP2 ranged from - 85.42% to -2.89%, with a mean change of -40.18%. The maximum muscle decay observed during the stay was - 50.61%. After a mean follow-up period of 438.73 days most patients (81%) were able to increase their muscle mass. Compared to muscle status at TP1, only 27% of patients exhibited full recovery, with the majority still presenting a deficit of 31.96%.</p><p><strong>Conclusion: </strong>Muscle recovery in ICU patients suffering from severe AP is highly variable, with only about one third of patients recovering to their initial physical status. Opportunistic screening of post-ICU patient recovery using clinically indicated imaging and AI-based segmentation tools enables precise quantification of patients' muscle status and can be employed to identify individuals who fail to recover and would benefit from secondary rehabilitation. Understanding the dynamics of muscle atrophy may improve prognosis and support personalized patient care.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does IV fentanyl, frequently used in emergency departments, change QT_C value? A prospective observational study.","authors":"Ayşe Yekta Öztürk, Ayfer Keleş, Ahmet Demircan, İsa Kılıçaslan, Fikret Bildik, Mehmet Ali Aslaner, Secdegül Coşkun Yaş, Burhan Çomruk, Burak Şişik, Merve Türker, Aslıhan Küçük Albayrak","doi":"10.1186/s12871-024-02702-7","DOIUrl":"10.1186/s12871-024-02702-7","url":null,"abstract":"<p><strong>Background: </strong>Fentanyl is an opioid analgesic frequently used in the emergency department (ED) and is usually administered without knowing the QT_C values of the patients or being monitored. However, the effect of fentanyl on QT_C, prolongation or shortening, has not been elucidated. This study aimed to determine the effect of fentanyl on QT_C.</p><p><strong>Methods: </strong>This is a prospective observational study in the ED of a tertiary hospital on patients who received intravenous fentanyl for procedures other than intubation. ECG was performed before and at 1, 5, 15, 30, and 60 min after the initiation of fentanyl administration, and QT_C value was calculated. Primary outcomes were QT_C prolongation, defined as an increase in the QT_C to ≥ 500 ms or any increase in QT_C by ≥ 60 ms.</p><p><strong>Results: </strong>The study included 109 patients. Of these, 60 patients were male, and the median age was 40. Compared with the baseline QT_C value, statistically significant prolongation was detected at the 5th, 15th, 30th, and 60th minutes, with the maximum prolongation at 30 min, and the median was 13.08 ms. Most patients with QT_C prolongation were female and over 40 years of age. Clinically, none of these patients developed malignant arrhythmias during the 60-minute monitored observation period.</p><p><strong>Conclusion: </strong>Fentanyl prolonged the QT_C value statistically significantly. Although no patient developed malignant arrhythmia clinically, our results suggest that this QT_C-prolonging effect should be considered when using fentanyl in patients at risk of torsades.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-assisted interventions for perioperative anesthetic management: a systematic review and meta-analysis.","authors":"Kensuke Shimada, Ryota Inokuchi, Tomohiro Ohigashi, Masao Iwagami, Makoto Tanaka, Masahiko Gosho, Nanako Tamiya","doi":"10.1186/s12871-024-02699-z","DOIUrl":"10.1186/s12871-024-02699-z","url":null,"abstract":"<p><strong>Background: </strong>Integration of artificial intelligence (AI) into medical practice has increased recently. Numerous AI models have been developed in the field of anesthesiology; however, their use in clinical settings remains limited. This study aimed to identify the gap between AI research and its implementation in anesthesiology via a systematic review of randomized controlled trials with meta-analysis (CRD42022353727).</p><p><strong>Methods: </strong>We searched the databases of Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (Embase), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Institute of Electrical and Electronics Engineers Xplore (IEEE), and Google Scholar and retrieved randomized controlled trials comparing conventional and AI-assisted anesthetic management published between the date of inception of the database and August 31, 2023.</p><p><strong>Results: </strong>Eight randomized controlled trials were included in this systematic review (n = 568 patients), including 286 and 282 patients who underwent anesthetic management with and without AI-assisted interventions, respectively. AI-assisted interventions used in the studies included fuzzy logic control for gas concentrations (one study) and the Hypotension Prediction Index (seven studies; adding only one indicator). Seven studies had small sample sizes (n = 30 to 68, except for the largest), and meta-analysis including the study with the largest sample size (n = 213) showed no difference in a hypotension-related outcome (mean difference of the time-weighted average of the area under the threshold 0.22, 95% confidence interval -0.03 to 0.48, P = 0.215, I² 93.8%).</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis revealed that randomized controlled trials on AI-assisted interventions in anesthesiology are in their infancy, and approaches that take into account complex clinical practice should be investigated in the future.</p><p><strong>Trial registration: </strong>This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42022353727).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness and outcomes of epidural analgesia in patients undergoing open liver resection: a propensity score matching analysis.","authors":"Isarapong Pianngarn, Worakitti Lapisatepun, Maytinee Kulpanun, Anon Chotirosniramit, Sunhawit Junrungsee, Warangkana Lapisatepun","doi":"10.1186/s12871-024-02697-1","DOIUrl":"10.1186/s12871-024-02697-1","url":null,"abstract":"<p><strong>Background: </strong>Open liver resection necessitates a substantial upper abdominal inverted-L incision, resulting in severe pain and compromising patient recovery. Despite the efficacy of epidural analgesia in providing adequate postoperative analgesia, the potential epidural-related adverse effects should be carefully considered. This study aims to compare the efficacy and safety of continuous epidural analgesia and intravenous analgesia in open liver resection.</p><p><strong>Methods: </strong>A retrospective study was conducted, collecting data from patients who underwent open liver resection between 2007 and 2017. Propensity score matching was implemented to mitigate confounding variables, with patients being matched in a 1:1 ratio based on propensity scores. The primary outcome was the comparison of postoperative morphine consumption at 24, 48, and 72 hours between the two groups. Secondary outcomes included pain scores, postoperative outcomes, and epidural-related adverse effects.</p><p><strong>Results: </strong>A total of 612 patients were included, and after matching, there were 204 patients in each group. Opioid consumption at 24, 48, and 72 hours postoperatively was statistically lower in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). However, there was no significant difference in pain scores (p = 0.422). Additionally, perioperative hypotension requiring treatment, as well as nausea and vomiting, were significantly higher in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001).</p><p><strong>Conclusions: </strong>Epidural analgesia is superior to intravenous morphine in terms of reducing postoperative opioid consumption within the initial 72 h after open liver resection. Nevertheless, perioperative hypotension, which necessitates management, should be approached with consideration and vigilance.</p><p><strong>Trial registration: </strong>The study was registered in the Clinical Trials Registry at www.</p><p><strong>Clinicaltrials: </strong>gov/ , NCT number: NCT06301932.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The annoyance of singultus: a case report of a rare adverse effect after epidural steroid injection.","authors":"Shayla Mena, Ashneel Raj, William Caldwell, Amit Kaushal","doi":"10.1186/s12871-024-02682-8","DOIUrl":"10.1186/s12871-024-02682-8","url":null,"abstract":"<p><strong>Objective: </strong>Cervical epidural steroid injections (ESIs) can provide effective pain management for patients suffering from chronic neck pain due to various pathological changes of the cervical spine. There are several rare adverse effects reported from interventional pain procedures, including persistent hiccups (\"singultus\"). Based on a limited number of cases, we propose a modified treatment algorithm for this adverse outcome (Fig. 3).</p><p><strong>Case report: </strong>Singultus has been documented as an adverse effect of interventional pain procedures, including epidural steroid, facet joint, and sacroiliac joint injections. We describe the case of a general contractor who presented to our clinic with chronic neck pain and central canal stenosis. The patient received an uncomplicated lumbar ESI in the past and was recommended for a cervical interlaminar ESI. After an uneventful C6-C7 interlaminar ESI with dexamethasone, 1% lidocaine, and normal saline the patient developed singultus. Baclofen was sent to his pharmacy, but this was unsuccessful at alleviating his hiccups. The patient was subsequently started on chlorpromazine and found relief from his symptomatology.</p><p><strong>Conclusion: </strong>Persistent hiccups after ESI or interventional pain procedures can be treated with conservative measures and non-pharmacologic methods, with escalation to therapy with baclofen, gabapentin, pregabalin, metoclopramide, chlorpromazine, other antipsychotic or antidopaminergic agents, and possible dual or triple therapy if further indicated.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified thoracoabdominal nerve block via perichondral approach: an alternative for perioperative pain management in laparoscopic cholecystectomy in a middle-income country.","authors":"Luisa Fernanda Castillo-Dávila, Carlos Jesús Torres-Anaya, Raquel Vazquez-Apodaca, Hector Borboa-Olivares, Salvador Espino-Y-Sosa, Johnatan Torres-Torres","doi":"10.1186/s12871-024-02690-8","DOIUrl":"10.1186/s12871-024-02690-8","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic cholecystectomy is known for its minimally invasive nature, but postoperative pain management remains challenging. Despite the enhanced recovery after surgery (ERAS) protocol, regional analgesic techniques like modified perichondral approach to thoracoabdominal nerve block (M-TAPA) show promise. Our retrospective study evaluates M-TAPA's efficacy in postoperative pain control for laparoscopic cholecystectomy in a middle-income country.</p><p><strong>Methods: </strong>This was a retrospective case-control study of laparoscopic cholecystectomy patients at Hospital General de Mexico in which patients were allocated to the M-TAPA or control group. The data included demographic information, intraoperative variables, and postoperative pain scores. M-TAPA blocks were administered presurgery.</p><p><strong>Outcomes: </strong>opioid consumption, pain intensity, adverse effects, and time to rescue analgesia. Analysis of variance (ANOVA) compared total opioid consumption between groups, while Student's t test compared pain intensity and time until the first request for rescue analgesia.</p><p><strong>Results: </strong>Among the 56 patients, those in the M-TAPA group had longer surgical and anesthetic times (p < 0.001), higher ASA 3 scores (25% vs. 3.12%, p = 0.010), and reduced opioid consumption (p < 0.001). The M-TAPA group exhibited lower postoperative pain scores (p < 0.001), a lower need for rescue analgesia (p = 0.010), and a lower incidence of nausea/vomiting (p = 0.010).</p><p><strong>Conclusion: </strong>Bilateral M-TAPA offers effective postoperative pain control after laparoscopic cholecystectomy, especially in middle-income countries, by reducing opioid use and enhancing recovery.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}